We already know that Washington D.C. is America’s fittest city — at least according to a fitness index released earlier this month. But which cities are doing the worst?

Published by the American College of Sports Medicine, the 2014 American Fitness Index offers a snapshot of the state of health in a community and an evaluation of the infrastructure, community assets and policies that encourage healthy and fit lifestyles.
45. San Antonio

Score: 35.6 out of 100 points

San Antonio’s community health ranking — 48 out of 50 — brings down Alamo City’s overall health ranking. That’s in part due to its low walk score (34; target goal is 51).

As a majority, residents living there also fall short in their physical activity. Almost 18 percent of San Antonio residents smoke, too.

Other cities that just missed out on being among the worst five in the country? Those would be Columbus, Ohio (No. 40); St. Louis (No. 41); Orlando, Fla. (No. 42); Detroit (No. 43); and Birmingham, Ala. (No. 44).
46. Nashville

Score: 32.5 points/100

Nashville’s personal and community health rankings are low — ranking 45 out of 50 cities. The index says Nashville has a high death rate from cardiovascular disease; its diabetes death rate is also above its target goal.
47. Indianapolis

Score: 32.3 points/100

Indianapolis has the worst community health ranking of all the cities analyzed in the fitness index. Its walk score is 29; the target goal is 51.

It also falls below target goals in virtually all measures of community/environmental indicators including the number of parks, recreation centers, tennis courts, dog parks and ball diamonds per capita; and the percentage of residents either cycling or taking public transportation to work.
48. Oklahoma City

Score: 31.6 points/100

Dragging down Oklahoma’s City fit score is the personal health of residents living there. About 74 percent of its residents say they’ve exercised in the past 30 days; the target goal is almost 83 percent.

Few residents say they eat the recommended three or more vegetables weekly. Twenty percent of its residents also smoke, while 32.6 percent are obese.
49. Louisville, Ky.

Score: 25.7 points/100

Oddly enough, a city known for baseball (and those cool sluggers) don’t have fewer ball diamonds per capita compared to other big cities in the U.S.

That’s one reason Louisville is ranked near the bottom. It also has fewer parks, recreation centers and a low walk score. Additionally, it also has a higher smoking rate, obesity rate (32.8 percent) and a lower percentage of residents who are in “excellent” or “very good” health.
50. Memphis

Score: 24.8 points/100

Memphis is the least fit city in the world. That’s due to the city’s low percentage of residents meeting both CDC aerobic and strength activity guidelines; low percentage of fruit and vegetable consumption; a high obesity rate and high rates of smoking.

Furthermore, residents living in Memphis have higher rates of serious diseases including diabetes and cardiovascular disease.